Wound Care Practices Research Articles

Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice.

Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal. The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections. This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data. The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation. The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.

Identifying surgical wound care priorities from the perspectives of clinicians and health consumers in an Australian private healthcare context: a case study

Objective To identify the priorities and challenges related to surgical wound care from the perspectives of clinicians and health consumers / patients at a private hospital in Australia. Methods: Twenty-five clinical questions related to five surgical wound management topics were developed a priori and presented to four clinicians at a workshop. Questions were ranked by participating clinicians using a consensus building approach to identify the top two research priorities. One health consumer who had experience with a surgical wound was interviewed. Transcripts from the workshop and the consumer interview were analysed using a deductive approach. Results: The clinicians’ top priority questions focused on the importance of the consumer in their postoperative wound management, and the role of the wound care team in providing evidence-based care. The patient highlighted the vital role collaboration with clinicians played in the successful management of their surgical wound and continuity of care. Conclusion: Strategies to partner with consumers in the prevention of surgical wound complications can be successfully incorporated into clinical practice. Key points: What is known about the topic? While there are clear gaps in current surgical wound care practices, there is also increasing evidence that suggests wound care outcomes can improve when patients partner with clinicians. What does this paper add? Surgical wound care outcomes improved when clinicians prepared and worked with consumers using frequent education, support and assessment approaches. What are the implications for practitioners? Partnership approaches between clinicians and consumers in the prevention of surgical wound complications can be successfully incorporated into clinical practice.

Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users.

BackgroundInjury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan.ObjectiveThis study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users.MethodsA cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment.ResultsA total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care.ConclusionsOur study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

Quality indicators for a community-based wound care centre: An integrative review.

The purpose of this review was to identify the role and contribution of community-based nurse-led wound care as a service delivery model. Centres increasingly respond proactively to assess and manage wounds at all stages - not only chronic wound care. We conducted an integrative review of literature, searching five databases, 2007-2018. Based on inclusion and exclusion criteria, we systematically approached article selection and all three authors collaborated to chart the study variables, evaluate data, and synthesise results. Eighteen studies were included, representing a range of care models internationally. The findings showed a need for nurse-led clinics to provide evidence-based care using best practice guidelines for all wound types. Wound care practices should be standardised across the particular service and be integrated with higher levels of resources such as investigative services and surgical units. A multi-disciplinary approach was likely to achieve better patient outcomes, while patient-centred care with strong patient engagement was likely to assist patients' compliance with treatment. High-quality community-based wound services should include nursing leadership based on a hub-and-spoke model. This is ideally patient-centred, evidence-based, and underpinned by a commitment to developing innovations in terms of treatment modalities, accessibility, and patient engagement.

A Novel Point-of-Care Solution to Streamline Local Wound Formulary Development and Promote Cost-effective Wound Care.

To develop and implement a point-of-care digital solution to streamline the creation and maintenance of wound care product formularies and promote cost-effective wound management. Researchers used Design Thinking methodology to develop the Formulary Module, a point-of-care digital solution within a clinical and reimbursement decision support web application for wound care and hyperbaric clinicians. The module was implemented in a US hospital-based outpatient wound clinic as follows: A baseline list of products was established, with brands automatically grouped by product category. Brands within each dressing category were compared, and redundancy eliminated. Study authors assessed the financial impact of formulary implementation in the wound clinic by comparing inventory expenditure before and after implementation. Implementation of the digital Formulary Module resulted in a 36% decrease in products (67 to 43 across 22 types), 38.73% decrease in the monthly average dollar spent on chargeable products, 29.56% decrease in the average dollar amount spent on chargeable products per patient visit, and increased staff efficiency. The Formulary Module has the potential to increase the adoption of cost-effective practices in wound care significantly.

The safety of punch biopsies on hard-to-heal wounds: a large multicentre clinical trial

Objective: Punch biopsy is a simple and effective diagnostic technique used in hard-to-heal wound management. Histologic examination can rule out cancer in the wound bed or diagnose vasculitis in a hard-to-heal or suspicious ulcer. A biopsy can determine the level of bacteria in an ulcer when infection is suspected. Despite its use, health professionals practicing in wound clinics hesitate to perform punch biopsies. The reasons vary from the invasive nature of the procedure to a fear of complications. Methods: A multicentre clinical trial evaluated the addition of fluorescence imaging to clinical examination in determining bacterial burden in hard-to-heal wounds. The protocol required a 6mm punch biopsy of any area (up to three) suspected of having moderate-to-high bacteria levels either on clinical examination or fluorescence image. If clinical examination and fluorescence imaging both did not indicate bacteria, the health professional took a biopsy of the centre of the ulcer. The biopsies were performed under local anaesthesia after cleansing the ulcer bed with sterile normal saline. Haemostasis was achieved with direct pressure and the occasional topical clotting agent. All of the patients were followed for 30 days to monitor for adverse events. Results: A total of 350 patientis with wounds (diabetic foot ulcer n=138; venous leg ulcer n=106; pressure ulcer n=22; surgical site infection n=60; other n=24), enrolled by 20 investigators at 14 sites in the US, underwent a total of 412 punch biopsies. Haemostasis was achieved in all 412 biopsies. No biopsy sites required cautery or suture ligation to control bleeding. No subjects returned to the clinic secondary to bleeding. A patient developed an infection three days post-biopsy that could have been due to the punch biopsy. However, the patient was HIV-positive and the quantitative biopsy was positive for infection, biopsy bacterial load of 106 colony forming units (CFU)/g. Conclusion: This trial used a 6mm punch to obtain tissue for culture, histology and additional biomarker research. In daily wound care practice, a smaller 3mm punch suffices. Adverse events were rare despite the larger biopsy. Punch biopsies are a safe procedure for obtaining tissue for histologic or microbiologic analysis.

The Ears of a Hippopotamus: Quality of Venous Leg Ulcer Care in Gauteng, South Africa.

ABSTRACTOBJECTIVETo describe venous ulcer care and wound care practices in Gauteng, a province of South Africa, according to the Donabedian structure-process-outcome quality improvement model.METHODSForty-eight facilities were selected randomly from public and private wound care practices in Gauteng. Structured interviews were conducted with care providers via questionnaire to assess the structural aspects of the Donabedian model. Within these facilities, investigators randomly selected 160 patient files and extracted data using a checklist to assess processes implemented and outcomes reached for patients who had previously presented with lower-leg venous ulcers.RESULTSFacilities lack the necessary equipment to perform vital assessments. Handheld Dopplers were available in 66% (n = 48) of the facilities. Sixty-one percent (n = 48) of the personnel at the facilities indicated that they had no formal wound care training. Although the majority of files (92%, n = 147) indicated that an assessment tool was used, many elements were not evaluated comprehensively according to the best available evidence. Aspects such as smoking, body mass index, and anemia were assessed in fewer than 30% of the patients. Distinguishing between superficial and deep infection and the accompanying overuse of antimicrobials and antibiotics were among the challenges identified. Further, 71% of patients received compression therapy, although the ankle-brachial pressure index of only 30% of patients was known. In 27 cases (17%), the outcome was amputation.CONCLUSIONSFrom this survey, it is evident that not all clinicians providing wound care in Gauteng are adequately trained or fully implementing best practice guidelines, and the consequences are detrimental to patients, particularly in terms of amputation. This article highlights the need for improved legislation and regulation for practitioners who deliver wound care services.

Advanced nursing recovery therapy in the field of nanotechnology based on tetracycline hydrochloride type drugs

With the development of wound care theory and practice methods, the development of new materials and the improvement of sustained release and controlled release technologies, medical dressings will develop in the direction of multi-functionality, diversification and intelligence. This has also promoted the development of clinical care, better service for wound patients, new dressings, and new methods for wound care. Among many new dressings, nanotechnology-based polymer nanogels have good application prospects due to their good water retention properties and micelle stability properties. At present, a large number of researchers have developed a variety of wound care materials, which are widely used in clinical settings. However, due to the shape of the material or its characteristics, the mechanism of action of many materials has not been studied in detail. How to prepare a new type of wound dressing, which has multiple functions - integrating haemostasis, bacteriostatic, stimulating cell division and differentiation, accelerating tissue healing, moisturising and phlegm, etc., so as to achieve a good evaluation of patients' post-care recovery is. China's long-standing and urgent problem in the medical device market. Therefore, this study used the tetracycline hydrochloride drug doxycycline as an antibiotic drug for nano-modified dressings. Under the theoretical guidance of the interaction between wound healing and pH of microenvironment, a polyethylene glycol (PEG) modified PEG-doxycycline hydrogel nanocomposite dressing was prepared to study the stability of nanoparticles in the dressing. Physical and pH responsiveness, swelling behaviour of composite dressings, and physicochemical properties of drug release behaviour were studied. At the same time, in order to study the effect of the PEG-doxycycline nanocomposite hydrogel on the recovery of wound care in patients, this study applied the composite nano dressing to the clinic. Through the comparative study of patients' quality of life, wound healing, nursing satisfaction and treatment effect, the innovative application of tetracycline hydrochloride in the recovery of wound care of patients under nanotechnology is realised. The results of this study indicate that PEG-doxycycline nanocomposite hydrogel prepared under the guidance of nanotechnology can promote wound healing, shorten hospital stay and reduce complications. At the same time, the use of the dressing can also reduce the work of nursing, alleviate the suffering of the patient, improve the comfort of the patient, and greatly improve the nursing effect and effect on the patient. This has certain promotion and research value for the implementation of continuous nursing methods for patients with chronic wounds, which can be popularised in clinical practice.

Three Wound Care Quality Performance Measures Are Now Public: Why It Matters

Three Wound Care Quality Performance Measures Are Now Public: Why It Matters

Screening for Cardiovascular Disease Risk Factors in a Physical Therapist Wound Care Practice: A Retrospective, Observational Study

This study assessed the prevalence of cardiovascular risk factors in individuals seeking physical therapist services for an integumentary disorder in an outpatient wound care center. Using a retrospective, observational study design, records from patients who were screened upon initial evaluation by a physical therapist for cardiovascular risk according to the American College of Sports Medicine (ACSM) guidelines were abstracted. The screening process entailed assessment of current signs and symptoms of cardiovascular, pulmonary, or metabolic disease; an individual or family history of cardiovascular disease; whether the patient was considered obese; and whether the patient was a current smoker, had a sedentary lifestyle, dyslipidemia, elevated glucose, or blood pressure ⟩140/90 mm Hg. Patient demographics and wound history also were summarized and described, including wound type and duration and pain associated with the wound. Wounds then were classified by the physical therapist as either venous leg ulcers or nonvenous leg ulcers based upon the referring physician's diagnosis. Descriptive statistics and frequency distributions were calculated to assess the prevalence of individual cardiovascular risk factors, total number of cardiovascular risk factors, cardiovascular risk stratification, and patient disposition. Frequencies of individual cardiovascular risk factors, total number of cardiovascular risk factors, and cardiovascular risk stratification also were assessed between patients with venous leg ulcers and nonvenous leg ulcers using chi-square tests for categorical data and t tests for continuous data. The alpha level was set at P <.05. Among the 70 study participants (41 male, 29 female; mean age 63.5 ± 15.1 years), 38 were treated for venous leg ulcers and 32 were treated for nonvenous leg ulcers. Overall, 38 patients (54%) had a history of cardiovascular disease and 29 (41%) had current signs and symptoms of cardiovascular disease. Patients with nonvenous leg ulcers had a significantly higher frequency of having a family history of cardiovascular disease than patients with venous leg ulcers (28% vs. 8%; P = .03). According to the ACSM guidelines, 5 patients (7%) were considered low risk, 22 (31%) were moderate risk, and 43 (62%) were at high risk for experiencing a future cardiovascular event. Cardiovascular risk did not vary significantly according to wound type. The patient risk-stratification profile in this study strongly suggested physical therapists should screen for cardiovascular risk factors before prescribing aerobic exercise or other physical activity for all patients being seen for an integumentary disorder in an outpatient wound care practice.

Competence areas for registered nurses and podiatrists in chronic wound care, and their role in wound care practice.

To identify general competence areas for graduating registered nurses and podiatrists providing chronic wound care. The provision of care for chronic wounds involves a team of multiple professionals, and registered nurses and podiatrists play an important role. However, previous studies have found that registered nurses have limited competence in wound care. In addition, there are no standardised international competence areas for the provision of chronic wound care by registered nurses and podiatrists. A qualitative design was used in this study. The data were collected using six focus-group interviews with the following professionals: (a) registered nurses; (b) authorised wound care nurses; (c) nurse educators; (d) physicians; (e) podiatrists; and (f) podiatry educators (N=23). The data were analysed using inductive and deductive content analysis. COREQ guidelines were followed, See Appendix S1. The competence areas for registered nurses and podiatrists providing care for chronic wounds include knowledge, skills and performance in anatomy and physiology; aetiology, care and prevention of chronic wounds; and wound management and assessment. The competence areas also include a set of attitudes and values relating to chronic wound care and patients with chronic wounds. In nursing and podiatry education and in working life, teaching should focus on these areas of competence in chronic wound care. This would standardise and integrate education on wound care, especially that of chronic wounds. Wound care is an important part of clinical practice in nursing and podiatry. It is suggested that registered nurses and podiatrists need general competence in chronic wound care to carry out evidence-based, safe, high-quality and cost-effective care. These results could be used to define registered nurses' and podiatrists' competence areas and roles in evidence-based wound care as independent healthcare professionals.

Health professionals' perspectives on delivering patient-focused wound management: a qualitative study.

This study examined the perspectives of health professionals on the barriers and solutions to delivery of patient-focused wound management and outcomes. A qualitative, descriptive study design was used. Participants were health-care managers, clinical leaders, nurses and allied health members who are part of wound care services. Open-ended surveys were distributed to participants in a series of learning workshops, and data analysed to identify leading themes. A total of 261 participants took part and 194 surveys were returned (response rate: 74%). From the analysis five themes emerged: patient/family wound-related education; health professional wound-related education; implementation of evidence-based wound care and dissemination of evidence-based wound information across professions and contexts; teamwork and respectful communication within teams; and a higher value and priority placed on wound care through collaborative teams by managers, leaders and policymakers. Findings suggest that ongoing, system-wide education is needed to improve prevention, assessment, treatment and management of four wound types: venous leg ulcer (VLU), diabetic foot ulcer (DFU), pressure ulcer (PU) and surgical wounds. Health professionals are committed to delivering best practice in wound care. Participants identified that effective patient-focused, evidence-based wound care involves having a health-care system with a clear mandate to ensure wound care is a priority. A high value placed on wound care by managers and clinical leadership could transform the present systems. Additionally, effective and widespread dissemination of evidenced-informed practice information is crucial to positive patient outcomes. Education and team commitment for consistent and respectful communication would improve care delivery.

Management of wounds in the community: five principles

The care of any wound in the community requires multidisciplinary working between healthcare professionals. In this article, the authors offer five generalisable principles that colleagues providing community care can apply in order to achieve timely wound healing: (1) assessment and exclusion of disease processes; (2) wound cleansing; (3) timely dressing change; (4) appropriate (dressing choice; and (5) considered antibiotic prescription. High-quality wound care is an essential aspect of healthcare practice but lacks an evidence base and standardised practice at present. The practice and teaching of wound care should be more greatly emphasised in healthcare training for all disciplines.

Finnish Nurses’ Perception of Client-centred Wound Care

Client-centred wound care includes the dimensions of the client, professional, and care organisation, which are equal. The aim of this study was to describe the perception of client-centred wound care of nursing professionals in Finland who are interested and involved in wound care practice.

Group A Streptococcus outbreak among residents and employees of two skilled nursing facilities: North Carolina, 2017

In this report, we summarize the results of surveillance, on-site assessments, and molecular analysis conducted as part of a group A Streptococcus outbreak investigation in 2 skilled nursing facilities. We identified cases in 24 individuals (6 deaths) and infection prevention deficiencies. Isolates from 14 individuals represented the globally emergent clade 3 emm89 strain. Molecular analysis suggests that the 2 outbreaks were related. Wound care practices and 1 symptomatic shared employee may have facilitated transmission. Strict adherence to infection prevention practices is needed to prevent group A Streptococcus transmission.

Impact of an educational intervention on postpartum perineal wound care among antenatal mothers in Jos: A quasi-experimental study

Most women with stitched perineum after vaginal birth suffer some forms of postpartum complications. Pain is one of the distressing short term morbidity which interferes with the mother’s ability to carry out activities of daily living and care for her baby. Wound infection and dehiscence are usually seen in some cases. Supportive information on postpartum perineal wound care was given less attention during Antenatal health education sessions thereby making parturient unable to know and practice proper wound care that will aid healing. The aim of this study was to carry out an educational intervention then evaluate the impact of this intervention on practice of postpartum perineal wound care and wound healing. The design used for this study was quasi-experimental. A total of 200 mothers (100 interventions and 100 controls) were serially recruited purposively in antenatal Clinics. Instruments used for data collection consisted of a questionnaire and assessment tool. The instrument was reliable at Cronbach co-efficient alpha 78. Descriptive statistics such as frequency tables, percentages, bar chart, mean and standard deviations were used in analysis and Inferential statistics such as Chi-square and Pearson correlation were used in testing hypotheses. Participants in intervention group were given instructions on postpartum perineal wound care while those in control group received routine teaching on postpartum perineal wound care. The study lasted for 12 weeks. Findings indicate that mothers in intervention group on day 1 practiced perineal wound care; 91.88% implemented hygiene, 93.75% nutrition, 32.29% pain relief measures. On day seven, 92.50% practiced hygiene, 96.88% nutrition, 62.50% pain relief measures, 100% took their medications. Subjects in control group inadequately implemented the practice of postpartum self perineal wound care as seen in day 1; implementation of comfort measure was 3.3%, with 99.33% did not practice hygiene and none practiced eating food that prevents constipation but 99.67% adhered to their prescribed drugs because drugs are usually prescribed within 24 hours of delivery. Practice was found to influenced pain reduction in both group because as practice increased day 1 in intervention group, there was a decrease in pain intensity (r=-0.910; p<0.05) even though drugs are usually prescribed on discharge also, in control group as practice increased the second day, there was also decrease in pain intensity (r=-0.547; p=0.002). Women in the intervention group showed better wound healing process as 12.5% had severe pain on day 1 postpartum as against 20% in control group. On day 7 none in intervention group had gaped wound but 66.70% of them had gaped wound in control group. In conclusion, women who were taught postpartum perineal wound care practiced it and this resulted in better wound healing progress, therefore, it is recommended that postpartum self-perineal wound care be introduced to antenatal mother, guidelines on perineal wound care be made available in delivery centers, Midwives should encourage parturient to practice care while on admission and encourage mothers to practice care when discharged home.

Promoting Skin Care for Older Adults

Chronic conditions and age-related changes place older adults at increased risk for skin breakdown and damage to skin integrity, leading to poor outcomes that may impact quality of life. Although we cannot stop skin from aging, home care clinicians are in the best position to mitigate further skin problems and influence healthier outcomes for patients with skin issues. Home healthcare clinicians can improve skin health and well-being for older adults by incorporating simple but thorough systematic skin assessments at every visit. This includes identifying the patient's personal skin care practices and preferences. Home healthcare clinicians can intervene and address excessive moisture or extreme dryness of skin, use available resources for best practices in wound care, and educate about sun protection.

Nursing Practice on Post-Operative Wound Care in Surgical Wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Background: Postoperative wound healing has been a problem which causes high mortality in the developing world; postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing; however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.

Quality appraisal of clinical guidelines for surgical site infection prevention: A systematic review

BackgroundSurgical site infections (SSI) occur in up to 10% of surgeries. Wound care practices to prevent infections are guided by Clinical Practice Guidelines (CPGs), yet their contribution to improving patient outcomes relies on their quality and adoption in practice. We critically evaluated the quality of CPGs for SSI prevention during pre-, intra- and post-operative phases of care.MethodsWe systematically reviewed the literature from 1990–2018 using the Cochrane Library, CINAHL, EMBASE, MEDLINE, ProQuest databases and five guidelines repositories. We extracted characteristics of each guideline using purposely-developed data collection tools. We assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.ResultsCombined searches of databases and repositories yielded 5,910 citations. Of these, we reviewed 215 full text documents. The final sample included 15 documents: 6 complete CPGs, 3 CPG updates, and 6 supplementary documents. The overall %mean scores across AGREE II domains for CPGs were: 1) scope and purpose (%mean ± SD = 86.3±23.5); 2) stakeholder involvement (%mean ± SD = 64±31.0); 3) rigour of development (%mean ± SD = 68.7±30.6); 4) clarity and presentation (%mean ± SD = 88.5±16.7); 5) applicability (%mean ± SD = 44±30.2); and, 5) editorial independence (%mean ± SD = 61±37.6). Based on individual AGREE II domains and overall scores, we appraised 4 out of 6 CPGs (inclusive of updates) as “recommended” for use in practice. Overall agreement among appraisers was excellent (ICC 0.86 [95%CI 0.73–0.94] - 0.98 [95%CI 0.96–0.99]; p <0.001).DiscussionInternational interest in CPG development has resulted in refinements to methodologies, which has led to improvements in the overall quality of the product.Implications for translationGiven the domains that received the lowest scores, it is clear that we need more consumer involvement and better consideration of the implementation challenges with CPG uptake and sustainability.

Biopolymers: Applications in wound healing and skin tissue engineering.

Wound is a growing healthcare challenge affecting several million worldwide. Lifestyle disorders such as diabetes increases the risk of wound complications. Effective management of wound is often difficult due to the complexity in the healing process. Addition to the conventional wound care practices, the bioactive polymers are gaining increased importance in wound care. Biopolymers are naturally occurring biomolecules synthesized by microbes, plants and animals with highest degree of biocompatibility. The bioactive properties such as antimicrobial, immune-modulatory, cell proliferative and angiogenic of the polymers create a microenvironment favorable for the healing process. The versatile properties of the biopolymers such as cellulose, alginate, hyaluronic acid, collagen, chitosan etc have been exploited in the current wound care market. With the technological advances in material science, regenerative medicine, nanotechnology, and bioengineering; the functional and structural characteristics of biopolymers can be improved to suit the current wound care demands such as tissue repair, restoration of lost tissue integrity and scarless healing. In this review we highlight on the sources, mechanism of action and bioengineering approaches adapted for commercial exploitation.